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Alcoholic's Anonymous, Outcomes and New Research on Alcoholism

Allan Schwartz, LCSW, Ph.D. Updated: Feb 1st 2010

Alcoholic's Anonymous, Outcomes and New Research on AlcoholismHere at Mental Help Net and elsewhere on the Internet there is a stormy controversy over the issue of Alcoholics Anonymous (AA). The two major sides in this oftentimes contentious debate view AA either as a religious cult that does a lot of damage or an effective and helpful medium for those struggling with their addiction. All sides report their personal experiences as well as things they have read through their own researches. Now, there is additional evidence for everyone to consider in this hot debate.

Alcoholism is an extremely serious problem in the United States and worldwide. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA)nine percent of the U.S. population match the criteria for alcohol dependence and alcohol abuse. Of those who receive treatment, more than 50% relapse two to four years after treatment.

As NIAAA states, it is also an extremely complex problem with multiple variables that determine why people become addicted. Some variables include: severity of alcohol involvement, cognitive impairment, psychiatric severity, gender, meaning-seeking, motivational readiness to change, social support for drinking versus abstinence, sociopathy, and typology of alcoholism.

John F. Kelly, PhD, associate director of the Massachusetts General Hospital (MGH) Center for Addiction Medicine led a team of researchers in the study of AA participants.  The results showed that those participants who attended AA more frequently experienced a reduced incidence of depression and a reduced amount of drinking. "Perhaps the social aspects of AA helps people feel better psychologically and emotionally as well as stop drinking," according to Dr. Kelly.

The research team also used data collected from a large project done by National Institute on Alcohol Abuse and Alcoholism (NIAAA) called "Project Match." In the Project Match study, it was found that most of the participants experienced high levels of depression at the outset. However, the depressive symptoms were greatly reduced soon after the study began and remained low afterwards.

The purpose of the Project Match study was to see if matching an individual's psychiatric diagnosis to a specific type of alcohol treatment would improve the results in terms of maintaining sobriety. This did not prove correct. However, it was found that the quality of treatment has a lot to do with recovery from addiction.

It must be pointed out the Project Match was very careful to say that AA is NOT a treatment for alcohol addiction. According to Project Match, "Alcoholics Anonymous, is a mutual support fellowship rather than a formal treatment."

At the same time, they stressed the point that there are treatment programs that use the 12 step process started by AA. A twelve step process was one of the treatment modalities used in Project Match. The others were Cognitive Behavioral Therapy based on Social Learning Theory, and Motivational Enhancement Therapy.

All participants in the study improved with fewer symptoms of depression and longer years of abstinence. However, those who participated in the 12 step treatment program showed the highest level of improvement including abstinence. Still, the researchers believe it was the overall quality of treatment in all three categories that made the biggest difference. All participants attended AA meetings.

To quote Dr. Kelly, "Some critics of AA have claimed that the organization's emphasis on 'powerlessness' against alcohol use and the need to work on 'character defects' cultivates a pessimistic world view, but this suggests the opposite is true. AA is a complex social organization with many mechanisms of action that probably differ for different people and change over time. Most treatment programs refer patients to AA or similar 12-step groups, and now clinicians can tell patients that, along with supporting abstinence, attending meetings can help improve their mood. Who wouldn't want that?"

Studies of alcoholism are not over. Among the problems that will be studied are the combinations of treatments along with the new medications designed to treat this addiction.

Comment:

There are those who state that alcoholism eventually cures itself without any intervention needed from anyone. This is said by those who were able to reach and maintain abstinence by themselves. However, there are some real dangers connected with this philosophy. Even if there is truth to this assertion, there are too many people who die of alcohol related diseases and accidents. Alcohol harms the liver, brain and increases the risk of various cancers. The addiction makes life difficult not only for the individuals with the addiction, but for their friends, families, wives and children as well. There are multiple cases of domestic violence traceable to having been drunk and out of control at the time of the violence. Finally, there continue to be too many cases of DUI and fatal crashes due to the misuse of alcohol.

It seems logical to me that, if a person is getting treatment in the form of psychotherapy and needs the added support of something like to help remain abstinent, then it is worth the time and investment. Since AA costs nothing, the investment becomes even more meaningful.

I know this article will stir controversy. Once again, my hope is that people will be respectful while submitting their opinions and experiences with this important issue.

Your comments are welcome and encouraged.

Allan N. Schwartz, PhD

 

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    my experience with 12 step peogram - - Feb 18th 2012

    I became an addict at the age of 45.  I attended 2 or 3 meetings a week for several months but failed to achieve abstinence.  However, I believe that it is the social aspects of the program that is the critical factor.  Nearly every fellow addict i met had become addicted early in life. Their friends were other addicts and the program gave them the chance to socialise with non-users.  Many of these addicts did not really have friends - they had drug relationships.  I was extremely lucky to have had a couple of friends of 20 years or more who were non-users and they stood by me.  It is the supportive environment of non-users, rather than the 12 steps, that can be the basis for success.  Nevertheless, I still think that 12 step programs claim greater success than they provide.  We need long term studies done by objective researchers and on larger numbers

    Alcoholics Anonymous is NOT a cure for depression... - Melanie Solomon - Aug 31st 2010

    Hi,

    I do not know exactly where you are getting your research, but let me provide you with MY research statistics:

    Professor (and Doctor) George E. Vaillant of Harvard University is an enthusiastic advocate of Twelve-Step treatment, and is currently a non-alcoholic member of the Alcoholics Anonymous World Services, Inc. (AAWS) Board of Trustees. So he really wanted to prove the effectiveness of AA. To study the effectiveness of various methods of treating alcoholism, Vaillant compiled forty years of clinical studies. Vaillant and the director William Clark also conducted an eight-year longitudinal study of their own where Vaillant reported having followed 100 patients who had undergone twelve-step treatment. He compared those people to a group of several hundred other untreated alcohol abusers. The treated patients did no better than the untreated alcoholics. Fully 95% of the treated patients relapsed sometime during the eight-year period that Vaillant followed them.

    After initial discharge, only five patients in the clinic sample never relapsed to alcoholic drinking, and there is compelling evidence that the results of their treatment were no better than the natural history of the disease (spontaneous remission). What Professor Vaillant, a Trustee of Alcoholics Anonymous World Services, Inc. is candidly, clearly describing is a zero-percent success rate for his A.A.-based treatment program. And it was even worse than no help: The A.A.-treated group, with the death rate of 29%, had the highest death rate of any kind of program, significantly higher than all of the other programs. And those five people out of the hundred in the A.A.-treated clinic sample who successfully stayed sober for 8 years are just the result of that same old five percent spontaneous remission rate at work, again.

    Remember that these terrible numbers were reported by a Trustee of Alcoholics Anonymous World Services, Inc., by a real true believer in A.A., by someone who loves A.A. and was trying hard to make it look good, not by some harsh critic of A.A. who might be suspected of bias, trying to make A.A. look bad.

    So, let me recap the most important points here: Professor Valliant, a PROPONENT of AA, who was really trying to prove its effectiveness, could NOT do so. Only FIVE percent stayed sober (the same rate as spontaneous remission), but what's even worse, is that AA had the HIGHEST DEATH RATE, 29%, which was significantly higher than ANY other group! So it looks like AA is not doing that great a job at helping with depression after all.

    Luckily, there ARE alternatives to Alcoholics Anonymous, and it is imperative that as professionals in the field, you learn about them to effectively be able to help your clients who are suffering with an alcohol or drug problem. I am sure you have seen your fair share of clients who, for whatever reason, keep relapsing, over and over again, who can't seem to "get" AA...well, it just means that AA might not be the right program for them, and they have a RIGHT to know about all of their other options. I hope that you offer this to them. If you want a resource guide that provides ALL the information in one place, including a directory of treatment programs that provides alternatives beyond the traditional 12-step method, I suggest you get a copy of, "AA Not the Only Way." '

    Please feel free to contact me with any questions or comments. I look forward to speaking with some of you soon!

    Melanie Solomon-Author of, "AA Not the Only Way: Your One Stop Resource Guide to 12-Step Alternatives," 2nd Edition, Amazon.com Bestseller

    Expert Speaker & Witness for AA Alternatives

    http://www.aanottheonlyway.com

    aanottheonlyway1@gmail.com

    310-658-0990

    scrutiny - raysny - Jul 13th 2010

    "It must be pointed out the Project Match was very careful to say that AA is NOT a treatment for alcohol addiction. According to Project Match, "Alcoholics Anonymous, is a mutual support fellowship rather than a formal treatment." "

    Then why, if it is not a treatment, is it being compared to treatment methods? I believe the wording of the above is to avoid putting AA under the same type of scrutiny that the other methods were subjected to.

    Data Please - Ben Franklin - Jun 21st 2010

    Without looking at the data I might assume the participants are still on a "pink cloud"that is disparaged in the rooms. I am sure that the longer these clients experience the program and work the steps that the level of depression alleviation will look just like the precarious slope of the long-gone triennial surveys.

    The researcher's remarks are NOT the study. - Mona Lisa - Mar 31st 2010

    What is being quoted here is the researcher's concluding remarks, which do not really have anything to do with the study's findings; they aren't part of the substantive portion of the study.  Again, I have read the entire study and am prepared to discuss it with anyone who has also read it and knows what it actually says. 

    ML

    post-structural medicine? - speedy0314 - Mar 31st 2010

    as a graduate student in english, i had to do a lot of fudging & rhetorical tap-dancing to come up with something original to say about foucault's critique of james' readings of shakespeare.  in a pinch, you could just make s**t up, cite a mountain of obscure sources in hopes the lecturer couldn't be bothered to track them down for accuracy, & argue adamantly the most preposterous ballyhoo while trying to keep a straight face.  it never failed.

    the same seems to be the case with "alcoholism research".

    until the findings are independently confirmed by several other research teams (preferably using more current data [Project MATCH?], more rigorous & empirical test methodologies, & the introduction of alternative approaches to level the playing field) this 'study' & its findings can be read as biased, purely inferential hogwash.  it's not "new research" -- it's another flake with a PhD. suggesting 12x12 yields a clinically observable result based on conjecture & [almost certainly] a very liberal massaging of the numbers.

    there's years more research & 'evidence' of the efficacy of st. john's wort for the alleviation of depressive symptoms in alcoholic & non-alcoholic patients -- never mind the widely accepted use of pharmaceutical anti-depressants in both cases.  still, some yahoo suggests 12x12 alleviates depression (without any independent confirmation) & you're all over it.

    your blog posts are long on hyperbole ('alcoholism' gets conflated with the even more amorphous conditions of 'alcohol abuse' & 'alcohol dependence' [the more widely accepted clinical descriptive terminology -- your prejudices are showing!] & labelled a 'serious worldwide problem' without a shred of substantiating data) & woefully short on real science.  as dr. harriet hall asked of you a few months back, "where's the evidence?"

    a meta-reading of the Project MATCH data & literally hundreds of discussions with the knuckleheads outside AA meetings definitively suggests to me that physicists can find the bulk of the universe's 'dark energy' in 12x12-related activity.  i'm happy to show you my data (i worked the equation out on the back of a starbuck's napkin).  think you can get a blog post out of that?

    funny - maybe riduclous - kevin - Mar 30th 2010

    i find this research data or lack as well suspicious. first, i find no material for footnotes, and lastly the co-founder of AA Bill W suffered acute and prolonged (decades) bouts of depression. Highly suspicious data collection/methods doctor schwartz.

    AA and depression - raysny - Mar 28th 2010

    Dr. Kelly's remarks are being quoted all over the internet as some sort of proof that AA cures depression.

    AA has a huge dropout rate, studing people in AA neglects all those who chose to leave.

    I believe that people who suffer from depression and anxiety disorders do not respond well to the powerlessness concept and ego-deflation of the program and don't stick around.

    Thanks Mona Lisa - MeMay - Feb 8th 2010
    Thank you for the info.I am going to read up on that. MeMay

    Disease concept - Mona Lisa - Feb 8th 2010

    For an interesting perspective on the disease concept, including the history of its acceptance by the US medical community, see http://www.baldwinresearch.com/alcoholism.cfm

    According to this website:

    The disease concept originated in the 1800s with a fellow by the name of Dr. Benjamin Rush. He believed alcoholics were diseased and used the idea to promote his prohibitionist political platform. He also believed that dishonesty, political dissention and being of African-American decent were diseases. The "disease concept" was used throughout the late 1800s and early 1900s by prohibitionists and those involved in the Temperance Movement to further a political agenda. Prior to this time, the term alcoholic did not exist. Alcohol was freely consumed, but drunkenness was not tolerated. Many sociologists contribute its non-existence to the very stigma that the disease concept removes.

    . . .

    The "recovery" community's adoption of the disease concept began with an early AA member named Marty Mann. Her efforts, combined with a somewhat dubious scientist named E.M. Jellinek, began national acceptance of the disease concept. It was Jellinek's "scientific" study that opened the door for the medical communities' support. E.M. Jellinek's study was funded by the efforts of Marty Mann and R. Brinkley Smithers. And, like so many other circumstances involving Jellinek and Marty Mann, the study was bogus if not outright fraudulent. The surveys he based his conclusions on were from a hand picked group of alcoholics. There were 158 questionnaires handed out and 60 of them were suspiciously not included. His conclusion was based on less than 100 hand picked alcoholics chosen by Marty Mann. Ms. Mann, of course, had a personal agenda to remove the stigma about the homeless and dirty alcoholic or "bowery drunk" in order to gain financial support from the wealthy. By removing the stigma, the problem becomes one of the general population, which would then include the wealthy. The first step was Jellinek publishing his findings in his book "The Stages of Alcoholism" which was based on the selective study. Later, E.M. Jellinek was asked by Yale University to refute his own findings. He complied. E.M. Jellinek's Stages of Alcoholism did not stand up to scientific scrutiny.

    Early in the 20th Century, the validity of the disease concept was often debated in medical circles. However, in 1956 the American Medical Association (AMA) proclaimed alcoholism an "illness." Then, in 1966, the AMA proclaimed alcoholism a disease. The decision was wrapped in controversy. Historically, Marty Mann had her hand in much of this and manipulated information and doctors into agreeing with the disease concept. Marty Mann used her position as founder of the NCA (National Counsel for Alcoholism) to promote the disease concept through Jellinek and a somewhat clandestine relationship with the founder of the NIAAA (National Institute for Alcoholism and Alcohol Abuse) whose founder worked with Marty Mann during the institute's early development. The founder of NIAAA (R. Brinkley Smithers) was a major contributor to and promoter of the disease concept. It was his money that actually funded Jellinek's work at Yale. Smithers was also responsible for gaining insurance coverage for patients in treatment (hence the 28 day program). Smithers was certainly not altruistic in his efforts. At that time he had already launched a treatment program for which he was lobbying for insurance payments. Acceptance by the medical community was the only way this could happen; alcoholism had to be a medical problem in order for medical insurance to pay for programs. We can see the influence of these "advances" everyday in treatment programs. Today the treatment industry is a multi-billion dollar industry, with insurance paying the lion's share of the costs.

    The History of The disease Theory - MeMay - Feb 8th 2010
    Can we take a look back at the history of the disease theory of alcoholism? I think it is important to look at WHEN this came about, WHY it came about, WHERE it came about, and the MAJOR SUPPORTERS of this theory (ex: Christian groups, Pro-Prohibition groups,Temperance groups, AA etc) I am sure some of you are very informed regarding this subject. I am not but I am willing to read up on it. Any recommended books to read on this subject? Can we have a short discussion on these forums about it or can Allen start another blog topic on this? MeMay

    Allan-Opps, My Mistake-Sorry - MeMay - Feb 7th 2010

    I just re-read your post and noticed that you were not stating things you think of as facts but rather beliefs that may or may not apply. My mistake for not reading your post a little more thoroughly. I am sorry for that. Take care.

     MeMay

    The value of psychotherapy - Mona Lisa - Feb 5th 2010

    It seems to me that some form of professional therapy can be beneficial, some of the time, for some people who are in the process of quitting an addiction. This is not a universal thing.  In my own case, I spent several years in therapy with an absolutely wonderful social worker who pushed me hard and helped me get my head on straight.  I don't give her or anyone else the credit for my long-term abstinence, but there is no doubt in my mind that she helped me (whereas, on balance, AA membership was, for me, a negative).

    But therapy is simply a tool in the toolbox.  Not everyone needs it or wants it, and those who do may benefit from different therapeutic approaches.  Same with support groups.  Not everyone needs or wants them, and those who do may gravitate towards different ones, with different approaches.  Same with craving-reduction meds.  One size does not fit all.

    I absolutely do not think it is appropriate to say that every addicted person must follow the same path.  This is false, misleading, and denigrates the recovery of anyone who didn't use the "correct" route.

    ML

    Really? - MeMay - Feb 5th 2010

    " If and when a person wants to change, really good psychotherapy must be an important part of the process. If they have an underlying ADHD, Major Depression, etc, that must be addressed sooner or later."

    I am reading a book titled 'Crazy Like Us: The Globalization Of The American Psyche' by Ethan Watters. I recommend it to you. After reading your above comment to J.R. I wish you would read it more.

    Am I the only one who sees something terribly wrong with this way of thinking?

    MeMay   


    agree with your assessment - - Feb 4th 2010

    Hi JR,

    I agree with your assessment of the war that seems to continue over there, on Dr. Dombeck's blog. Yes, its peaceful here but some of the comments about my artcle are over there instead of here. I thought that a bit wierd myself. But, oh well.

    You are making a good point and raising a good question. I don't know the anwers. I only have my impressions, some from reading, some from experiences with patients and some from my experiences with people in my family. It seems to be this...maybe???.....

    I. Regardlesss of treatment method, modality or anything else, people must feel motivated to want to end their addiction. No one, no Judge, Court, or family or friends, can talk or force someone into wanting to end the addiction, of whatever type it is.

    2. If and when a person wants to change, really good psychotherapy must be an important part of the process. If they have an underlying ADHD, Major Depression, etc, that must be addressed sooner or later.

    3. Once motivated, the individual must take part in the treatment program, twelve step or not, and that means fully participating.

    After all of this or during it, participation in a support program can further help. Here is the thing: That support program can be Smart Recovery, AA or any other of the many programs people have advocated. In other words, there is something helpful about the peer support that seems to help in these non treatment self help groups.

    These are ideas and, in the end, I don't know. Now, medications are becoming an increasingly important part of the treatment process.

    What do you think??

     Allan

    Quality of treatment. - JR - Feb 4th 2010

    Hello, Allan,

    Relatively peaceful Over Here - I note that Dr Dombeck's "Cult" blog continues to look a bit like one of those "fight" scenes from old Tasmanian Devil cartoons - rapidly spinning clouds of claws, fur and dust, with little real transparency.  Oh well, I am done with that.

    One comment struct me particularly about your article here - relating to the conclusion that it was the quality of the treatment modality, rather than its substantive approach, that reflected in more or less successful treatment outcomes.  I am interested in this because, having gone through a 12-Step facilitation-based rehab myself, I know that persons participating (for whatever reason) in such processes have their own way of surviving them should they find the "spiritual" message unpalatable - which, at its simplest, is to mouth the appropriate words while maintaining an inner reservation.  Furthermore, it is surprising how quickly a group like this can develop a sort of subversive boarding-school sub-culture, whereby this sort of covert "resistance" is supported, even by members of the group who have not actually rejected the message themselves, on the basis of group solidarity.  "Resistants" in these circumstances are most likely to be people who have previous experience of AA or of 12 Step facilitation-based rehab and who have already formed their own, negative conclusions.

    As 12-Step facilitation-based treatment must, very often, find itself addressing mixed groups of totally uninformed, confused, and initially receptive newcomers (as I was in my time), totally confused, uninformed and immediately "resistant" patients, and "experienced" rejectionists, I find it difficult to fix on the qualty of "quality" that would produce a difference in outcomes that could be attributed to this form of treatment across the board.

    I would be interested in any comments you might wish to offer on this point.

    Best regards as always (hope this is respectful !)

    JR.

    Question - Allan N. Schwartz, PhD - Feb 3rd 2010

    Hi ML,

    Thanks to you and people like you, my awareness of alternatives has been raised and I will recommend alternatives like "Smart Recovery."

    Allan

    A question - Mona Lisa - Feb 3rd 2010

    Allan, I agree completely that people should have a choice regarding peer-support groups.  I also agree that SMART Recovery is an excellent choice. 

    But how will people know that they have this choice if mental health professionals (such as yourself) do not mention the alternatives?  All too often, it seems, when someone mentions that they have an addiction, the response is that the person should go to a 12 step program, period, with nary a mention of choice.

    ML

    Causality Runs Both Ways - Allan N. Schwartz, PhD - Feb 2nd 2010

    Dr. Steinberg,

    I am not sure of the point you are making about causality as this blog has nothing to do with causality. However, it is true that people should have and do have the right to attend the programs of their own choice. Smart Recovery is excellent. That is just it: People should have a choice. The emphasis here is on choice. Too many of our participants here insist that AA is not and should not be a choice and I disagree.

    Response - Mona Lisa - Feb 2nd 2010

    Allan,

    It's hard to really discuss a study that most of us won't have access to.  I can read it, but since it's in an academic journal and just came out, I imagine that most on this forum won't be able to see or comment on it.

    Anyway, it's a large study (1706 participants), which is good, but it doesn't seem, from what I can see, to show that AA has any impact on depression other than that which would be expected to occur naturally as a result of abstaining from alcohol. To quote the study itself:

    "when concurrent alcohol use was controlled to test the independent effect of AA on depression symptoms, the contribution of AA attendance in predicting depression symptoms was rendered nonsignificant. This suggests that the salutary influence of AA on reducing depression is related to, and may be explained by, AA’s proximal effect on reducing alcohol use."

    [As an aside, it's interesting how the study carefully states that AA is correllated with and associated with abstinence rather than saying that there is a causal relationship.  That's because an actual causal relationship has not been shown.]

    I also note that despite the size of this study, the vast majority of the participants were employed, white males (as are most AA members) so are the results of this study, even if they are valid, generalizable to others?

    I'd be happy to talk about this study some more, if anyone else has access to it and can actually read it.

    Meanwhile, how about if we discuss the results of the NESARC study?  That's a really cool one:

    http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.pdf

    ML

    Causality can run both ways. Either way SMART Recovery can help - Dr. Henry Steinberger - Feb 2nd 2010

    The lessened depression of those who went to more meetings might also reflect that the more seriously depressed as a result of their depression went to less meetings. Fatigue and loss of motivation are symptoms of major depression, so what was shown is that the healthiest go to more meetings, rather than that meetings cure depression. Also note that depression by its nature comes and goes, so improvement over meetings also reflects natural recovery from depression and over-drinking.

    And note too that allowing people to choose what type of assistance they prefer, faith-based AA/12-Step or one of the secular alternatives (SMART Recovery, SOS, LifeRing, Women For Sobriety, 16-Step Women's Discovery) improves participation and so outcome, as demonstrated in: Religiosity and participation in mutual-aid support groups for addiction Randolph G. Atkins, Jr., Ph.D. and James E. Hawdon, Ph.D. Journal of Substance Abuse Treatment, Volume 33, Issue 3, October 2007, Pages 321-331. If this blogger would be so kind as to read this, I think we could move past the endless and useless debate noted at the start of this blog.

     

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